By the time Marshall Carpenter’s father broke down the barricaded door of his son’s apartment and physically ripped him away from his electronic devices, the 25-year-old was in a bad way. He could not bear to live a life that didn’t involve hours upon hours of uninterrupted screen time.

“I was playing video games 14 or 15 hours a day, I had Netflix on a loop in the background, and any time there was the tiniest break in any of that, I would be playing a game on my phone or sending lonely texts to ex-girlfriends,” Carpenter says.

We are sitting in a small, plain apartment in a nondescript condo complex in Redmond, Washington, on the outskirts of Seattle. Marshall shares the apartment with other men in their 20s, all of whom have recently emerged from a unique internet addiction rehab program called reSTART Life.

“I was basically living on Dr Pepper, which is packed with caffeine and sugar. I would get weak from not eating but I would only notice it when I got so shaky I stopped being able to think and play well,” he adds. By then, he’d already had to drop out of university in Michigan and had lost his sports scholarship.

His new friends Charlie and Peter nod sagely. Charlie Bracke, 28, was suicidal and had lost his job when he realized his online gaming was totally out of control. He can’t remember a time in his life before he was not playing video games of some kind: he reckons he began when he was about four and was addicted by the age of nine.

For Peter, 31, who preferred to withhold his last name, the low came when he had been homeless for six months and was living in his car.

“I would stay in church parking lots and put sunshades up on the windows and spend all day in my car on my tablet device,” he says.

He was addicted to internet porn, masturbating six to 10 times a day, to the point where he was bleeding but would continue.

When he wasn’t doing that, he was so immersed in the fantasy battle game World of Warcraft that in his mind, he was no longer a person sitting at a screen, but an avatar: the bold dwarvish hero Tarokalas, “shooting guns and assassinating the enemy” as he ran through a Tolkien-esque virtual realm.

And when he wasn’t doing that, he would read online news reports obsessively and exercise his political opinions and a hair-trigger temper in the comment section of The Economist, projecting himself pseudonymously as a swaggering blogger-cum-troll.

“I was a virgin until I was 29. Then I had sex with a lap dancer at a strip club. That’s something I never thought I would do,” he says.

After completing the initial $25,000, 45-day residential stage at the main “campus” a few miles away, clients move into the cheaper, off-site secondary phase. Here they get to share a normal apartment, on the condition that they continue with psychotherapy, attend Alcoholics Anonymous-style 12-step meetings, search for work and avoid the internet for a minimum of six months.

Marshall, Charlie and Peter successfully completed the second phase and have graduated from the reSTART program, but they have chosen to stay in the same apartment complex and rent with other recovering gamers as they continue to reboot their lives.

Mostly they carry only flip phones and have to go to the library when they want to check email.

“I’m taking my life in six-month chunks at this stage. So far I haven’t relapsed into gaming and I’m feeling optimistic,” says Bracke.

An addiction overwhelmingly afflicting men

A climbing wall at the main reSTART campus, deep in the woods. Photograph: Rafael Soldi/The Guardian

Nine miles east, down a dirt track off a country road that winds through forests, six young men are sitting in a wooden cabin amid a cluster of moss-draped trees – the reSTART campus.

Spring sunshine is flooding through the windows and the only sounds are birds singing and the men cracking their knuckles as they stare at the floor.

They have recently arrived at rehab.

Hilarie Cash, a psychotherapist and the chief clinical officer at reSTART, asks the guys to begin a communication exercise.

Philip, 22, steps into the middle of the group. He’s been here for three weeks and is on a year’s medical leave from Duke University after getting hooked on Dota 2, the sequel to the fantasy battle game Defense of the Ancients. He asks Adam, who only arrived four days ago and is fidgeting awkwardly, to stand up and face him. (The real names of those currently in the residential program have been withheld.)

Kevin, who has been here for four weeks, coaches them through an exercise known in counseling circles as the “listening cycle”, designed to facilitate emotional conversations in relationships.

It’s a basic introduction for the new guy.

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Philip, who was underweight when he arrived, says to Adam, who is overweight: “I’m worried that you’re not eating healthily. I noticed you’ve been skipping dinner.”

Adam is meant to repeat back to Philip what he heard him say the problem is. He mumbles, barely audible, and can’t seem to remember what he’s just been told.

He’s unable to focus, and the air is thick with reluctance and embarrassment.

Stephen, another newbie, is gazing at the ceiling, yawning, sighing, then looking mildly irritated.

Alex, 20, comes to the rescue. He arrived at rehab in January but has popped back to visit the group and explains: “It’s so hard at the beginning. Day one here, I was a wreck, and the first two weeks I was backsliding.”

His games of choice were The Legend of Zelda, a solo action adventure series, where “instead of being the depressed piece of shit I was in real life” he could exist as a swashbuckling hero.

Adapting to a tech-free world structured around rural communal living and social skills was a nightmare, he says. “I wouldn’t join in at first and I got called out for it by the others.”

The softly spoken Cash, the chief clinical officer, has been sitting quietly in the corner of the cabin, and now she shoos the group off to complete chores before lunch.

They disappear to the main house, where there are no electronic devices of any kind, and only a limited selection of approved books. They can call home from a landline. There’s a piano, some drums and the house dog, an Australian shepherd called Dakota, who sits in on group sessions and seems widely adored.

They do all their own cleaning and laundry and communal cooking of healthy meals. They must make their beds before 9AM and have group therapy or lighter emotional check-in sessions morning, afternoon and night in the large central room, interspersed with regular appointments with individual therapists. (The Guardian was not granted access to therapy sessions.)

There’s a well-equipped gym and, outside, close to the surrounding woods, is a giant stone chess set, a fire pit and a vegetable garden for the guys to enjoy.

And yes – it’s all guys. Cash says that in the eight years of reSTART, they’ve treated more than 150 men, but only six women.

“Very broadly, my theory is that girls really are more sociable and desire social interaction to a higher degree than boys,” she says. Cash often addresses the men as if they’re children, but when challenged on that later sounds taken aback and says it’s not intentional.

reSTART launched a program for 13- to 17-year-olds this year at a nearby site and there’s already a waiting list. The adult program is for 18- to 28-year-olds, with a maximum of six at a time in the residential phase.

It has a name: internet gaming disorder

It’s still early days for research. Cash says experts believe that between 1% and 13% of the US population has some level of internet addiction, and up to 20% of young adults.

All residents do all their own cleaning, laundry and communal cooking of healthy meals. Photograph: Rafael Soldi/The Guardian

“There isn’t consistent criteria to measure this yet,” she says, nor is there agreement in psychiatry that one can be addicted to the internet. But Cash says research has “accumulated to the point where something called internet gaming disorder has made its way into the back section of the the Diagnostic Statistical Manual (DSM), meaning it’s being considered for future possible inclusion.”

The DSM is the handbook of the American Psychiatric Association and is considered the standard US reference book for mental health.

Cash was disappointed that the current, fifth edition, DSM-V, which was updated in 2013, left out sex addiction. But it included gambling disorder for the first time, after 40 years of study.

“Gambling became the first behavioral addiction to be recognized and that opened up the mind-boggling concept that behaviors alone can be addictive – and just as powerful as a chemical addiction,” she says.

The chase and reward patterns of betting, hooking up or advancing in a competitive video game are not unlike a drug high and can become similarly compulsive even though a foreign substance is not being introduced to the bloodstream, Cash and many other experts believe.

“The way a gamer’s brain lights up in euphoria and builds up a tolerance to the rewards, distorting the neuro pleasure pathways over time, is similar to a cocaine addict,” she says.

Cash says some games are much more addictive than others and that they are designed that way, especially the endless massively multiplayer online role-playing games (MMORPGs), amid the estimated $91bn global gaming industry. And they are largely designed by men to appeal to males.

“We used to call World of Warcraft gaming’s crack cocaine, but now that title has passed to League of Legends,” another online game, she says.

Players team up with others online and plan mass battle missions together, often chatting on Skype to their online friends. They debate the games on internet forums and social networks including Facebook, Reddit and 4chan, and can watch people playing via live streaming on YouTube, in an intense, highly competitive, quasi-social life filled with jargon and raw language.

Cash is concerned that parents don’t understand how addictive screens are for little children and detrimental to their mental development, especially interactive activities. And she is downright alarmed about the dangers of the nascent virtual reality medium.

In many ways, reSTART is like any other rehab place: first detox, and then face underlying mental health problems, personality traits or life traumas that fuel the dependency and learn how to communicate about that, and finally figure out how to abstain or use in moderation.

“We require abstinence from the internet for the duration of the program and then slow reintegration of technology – but extended abstinence from the things that caused the problem,” she says.

They said: ‘This is an intervention’

Vignettes used in group therapy. Photograph: Rafael Soldi/The Guardian

The next day, Andrew Fulton walks into the main house for his shift as a care manager organizing the guys’ schedules.

He’s an ex-client.

“A two-timer, actually. I came here, I relapsed, I came back,” he says.

He first arrived in 2013.

“The first few days after getting here are weird. It’s a version of cold turkey because you’ve been gaming around the clock and suddenly, nothing. I would sweat a lot at night and get headaches. I would lie in bed and perfectly visualize the games I would play. I was craving them, I dreamt about them,” he says.

Fulton, 22, grew up near Seattle and his father worked for Microsoft. His parents limited his access to a games console, but as a teen, Fulton saved up and bought his own.

“I was socially awkward. In middle school, I went through the whole identity crisis thing, and in high school, I never had a girlfriend or anything,” he recalls.

Fulton thought his gaming was under control until he went to college. There, he found he had no desire to meet new people. “I had a couple of friendships, I guess, but I put no energy in and they fell apart,” he says.

“I went to classes at first and then I just started watching YouTube videos all the time, bullshitting around with message boards, the meme culture and gaming,” he says.

He pretended to be sick and thought he would catch up with class soon enough, until he was gaming until 1AM, then 3AM, 5AM, 8AM.

He bought a case of Coca-Cola and stocked up on bread and Lunchables and, for three weeks, immersed himself online and left his room only to use the toilet. “I think I had two showers in that time and I wasn’t really brushing my teeth,” he recalls.

When a student finally raised the alarm and Fulton, then 19, saw a counselor, he was diagnosed with mild depressive disorder.

“They just said: ‘Here’s some Prozac.’ I felt horrible, I weighed 127lbs, I was frail and felt nauseated a lot. I wanted to numb myself and escape, so I’d get lost in the game fantasy world but then I would feel worse, so I’d want to numb more – it feeds on itself,” he says.

He had “some sort of breakdown” and took off on a west coast road trip, to San Diego and back, doing little more than driving and logging on in motels.

Once back, he got a call from one of his grandparents, inviting him round to look at their vacation pictures.

“I went and my grandparents and my parents were there and then my little sister showed up from school and she had this strange guy with her called Scott. They said: ‘This is an intervention.’ An hour later this guy was driving me to reSTART and I stayed there for eight months,” he says.

In that hour, his family told him the effect his gaming habit had had on them.

“I just sat there and stared at the ground and shut off from my feelings while they talked,” he says.

His 17-year-old sister’s words did penetrate, however, and were “hard to hear”.

“She said that growing up she felt like she didn’t have a brother and that I wasn’t going to be there when she graduated or got married.”

Eight months later, things were looking better. He was healthy and had found support among the recovering gamers at reSTART. He went back to college.

“Big mistake,” he says. He didn’t have his computer but he also didn’t have his new rehab friends and was not as emotionally robust as he’d thought.

He found a new way to escape. After quaffing his roommate’s Nyquil and finding it delightfully numbing, he started taking huge doses of the over-the-counter cough syrup with dextromethorphan, aka DXM, a cough suppressant.

“They call it dexing or Robotripping,” he says, after the popular cough medicine brand Robitussin. If you chug enough DXM, it provides a high similar to combining booze, weed and mild acid, Fulton explains. Side effects include stumbling about like a hallucinating robot that’s blown a fuse, a frazzled serotonin system and an engulfing sense of dread.

Then there were the messy attempts to find a girlfriend.

“It got creepy, sort of stalky. It was bad,” he says.

All came crashing down when he overdosed and was lurching around a supermarket with a knife, texting one of the women he was obsessed with and planning to kill himself in the grocery aisle.

The woman called 911 and Fulton was handcuffed and taken away in an ambulance, spending three days locked in a psychiatric facility.

“My parents said: ‘We own your health insurance, we own your car, we own your phone plan and we’ll take these away if you don’t go to rehab.’ I said no. They took them away, I was homeless for two weeks, couch-surfing, and then I called Scott,” he recalls.

He first went to drug rehab, where some addicts scoffed at his cough syrup and gaming problems, then went back to reSTART. He says he faced the cravings, “faced myself” and finally struggled out of the cycle of depression and escapism.

He then embarked on a nine-month nature course, swapping an emotional wilderness for actual, verdant, Pacific north-west outdoor wilderness. These tales of oblivion are hard to reconcile with the confident person, all trendy beard and brow stud, now jovially wrangling the rehab guys to go outside.

Fulton gathers them to sit on logs around the fire pit.

He begins patting his chest rhythmically and singing a campfire song about wolves, ravens and a grandmother’s dreams. Some sing along enthusiastically, while the newer guys mumble self-consciously. Kevin is looking at the ground and his lips are barely moving. He can’t bring himself to sing but he’s patting his chest in solidarity. It’s a poignant scene.

Fulton leads some exercises in meditation and nature awareness, naming the trees and the plants around them. Then the guys spend an uproarious hour playing ballgames and a version of hide-and-seek in the woods, crawling around in the undergrowth, sticking ferns in their hair. There’s a lot of face-to-face chat, exuberant laughter, and mud.

Later, Fulton mentions, blushing slightly, that he has recently found a girlfriend.

‘It’s hard to tease apart what came first, the addiction or the depression’

Back at Charlie and Peter’s apartment, Bracke mentions that he, too, is beginning to think about dating. And Peter tells his roommates that his therapist has set him an exercise of asking a woman out for coffee – just as a getting to know you - and he’s trying to muster the courage and tactics to go about that.

Bracke works at Costco and is trying to complete his interrupted bachelor’s degree, studying accounting at a local college. Last year, he bought himself a smartphone and installed an app that monitored his use, to stop himself from gaming. Recently, he removed the app and has not lapsed.

Bracke says he was an earnest introvert as a young boy growing up in small-town Indiana, and reacted to being bullied by his extrovert older brother by retreating into gaming. Although his parents complained, he would retort that they watched too much television and he reminded them he was a straight-A student, so he mainly got away with it.

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Bracke’s habit escalated after his beloved grandmother died. Later diagnosed with depression, he discovered that serious depression haunted his mother’s side of the family and his grandmother’s grandmother had tried to kill her children and had killed herself. He also believes, however, as does Cash, the therapist, that compulsive gaming can cause depression from scratch.

As Cash says: “Sometimes it’s hard to tease apart what came first, the addiction or the depression.”

As for Peter, he still won’t allow himself anything other than a flip-phone. But he says “things are getting better fast” in his life.

He’s working as a park maintenance specialist, hiking in his spare time and has been accepted to do a law degree at a state university this fall.

Growing up, he was a math whiz, and his father, whom he described as a 350lb-plus food addict, would eat “three or four meals’ worth of food” while Peter did his algebra.

“When I’d finished, my dad would give me a crisp $5 bill and I would be allowed to go play in the video game arcade,” he says.

He blamed himself for not being able to fix his father. The death blew a hole in his life that Peter says he tried to fill by immersing himself online.

Looking back now, he says: “I think a lot of male problematic behavior is channeled into killing people on a screen. I had anger against the world. A paradoxical mix of entitlement and worthlessness and being upset that my life wasn’t going the way I wanted it to.

“I’ve noticed a lot of the trends in games are about ‘my father is lost and I have to find him’ on some quest,” says Peter.

The guys talk a little more about venting frustrations online, and boys not being taught how to communicate with each other very well.

So what did people like them do before the internet?

“Drink. Have sex. Murder people?” says Peter.

“Lots just killed themselves,” says Carpenter.

They let out barks of ironic laughter.

They look at their watches. Peter is going out to walk Charlie’s dog. Bracke is going to bed because his Costco shift starts at 4AM. Carpenter heads off to a 12-step meeting. No one checks their phones.

In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In the UK, Samaritans can be contacted on 116 123. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here